Chapter 1: Intro to Outdoor Emergency Care

Birth of Patrol

• • 1936 – Minnie Dole breaks his ankle at Stowe, waits at the top for 2 and a half hours, and ends up sledding down on part of a tin roof, unsplinted, and realizes, “hey, there should be someone there to make sure things like that don’t happen. Maybe someone to patrol the mountain..?” A star is born!

Patrol at War!

• • • WWII – NSP (Nat’l Ski Patrol) initiates the first Air Force Search and Rescue units, complete 52 missions Minnie Dole convinces US Army chief of staff that the army needs dope skiers who can shoot while they ski (Pierce Brosnan style), so Army creates what eventually becomes the 10 th Mtn. Division ’44 – 10 th goes to Europe, runs train on Nazi’s and playerhaters jealous of our unbelievable skiing

Meaningless Patrol History….

• • • • • ‘39 – NSP works with American Red Cross ’88 – OEC first developed by Dr. Warren Bowman Bowman creates idea of “intermediate care,” which is what we practice. (write that down, actually) Intermediate Care – providing care for a patient in a wilderness situation, continue during transport (toboggan, generally speaking), and further continue care in a first aid room or Patrol Hut. Then, patient -> hospital. We are the intermediaries between the injury and the hospital, where the patient will receive the rest of his medical attention, thus “intermediate care”

OEC Today

• • OEC = primary curriculum taught to first responders worldwide, “gold standard” of emergency care in nonurban environments Middlebury teaching of OEC = waaaaay chiller than standard

Training Overview

• • • • First: Patrol Basics 2nd: Human anatomy and physiology 3 rd : Assessing patients 4 th : Providing care to the patients (which involves “practicals” – basically practicing what you would do to actually help people)

Oh, the places you’ll go (and things you’ll know). How to:

• • • • • • • • • Assess safety, and maintain it at a rescue scene Use proper techniques to prevent unprotected contact with body fluids Assess a patient’s level of responsiveness Establish and maintain an airway Assess respiration and provide adequate ventilation Control bleeding ID and address life-threatening problems Save lives!!!!!

And more: p. 10 of the book.

Certification

• • • To receive OEC certificate of completion, OEC candidates must successfully complete the OEC course (obvi) Includes: written exam, and practical exams To be a Midd Patroller, also includes: Midd written exam (much more stringent than the OEC)

Ethical Issues

• • • • • • Respecting Autonomy (patient’s choice to refuse care) Do no harm (nonmaleficence) - standard.

Benefit others (beneficence) – standard.

Be just – balancing the rights of the indiv. Vs. those of others (drunk/disorderly patients and the safety of those around them) Be faithful – loyalty to your fellow patrollers, loyalty to a patient (not leaving them..) Be cool – in every situation, ask “what would Luke Rahlson do? Then don’t do that

Good Samaritan

• • Ski Patrol viewed as “good samaritans” (people who help other people but expect nothing in return) Therefore, how are we protected from legal harm? Good Samaritan Laws

Good Samaritan Laws

• • • • They protect patrollers – we’re not liable for any act or omission in giving any assistance or medical care if: 1 – the act of omission is not one of gross negligence (pretty impossible to become a Midd patroller if you’re “grossly negligent” 2 – the assistance or care is provided without fee or other compensation 3 – the assistance or medical care is provided at the scene of an emergency, in transit to a medical facility, or through communications with personnel providing medical assistance

Gross Negligence

Gross Negligence

• “An intentional failure to perform a manifest duty in reckless disregard of the consequences as affecting the life or property of another, and it also implies a thoughtless disregard of the consequences without the exertion of any effort to avoid them. Gross negligence can also be considered a wanton or reckless disregard of the injured person by the rescuer.”

Doctrine of Public Reliance

• • When in uniform, OEC technicians are expected by the public to come to a patient and provide care when someone is injured/needs help Therefore, the public relies on us, and we are legally bound to provide assistance to a person in need of such care, unless such an action places the safety of the rescuer (you) in doubt

Legal Terms

• • • • Abandonment: leaving a patient before either you’ve finished providing care, they have been transported to a hospital, they’ve asked you to cease providing care, or continuing such care places the rescuer (you) in harm’s way Negligence: performance below standards of training Breach of Duty: failure to perform a promised act or obligation of due care Duty to Act: a person’s legal obligation to provide something to another individual

Assumption of Risk

• • When a skier/boarder/TELE-ER!!!!! Chooses to participate in a totally extreme winter sport, they assume that the sport has inherent risks. So, if they get injured, it is officially their fault.

Documentation

• • • • • Part of being a patroller is filling out paperwork during and after providing care. Sucks, but it’s necessary in order to: A) prevent you from getting sued, B) establish and maintain an accurate record of events, C) give other medical care providers an accurate picture of the patient’s state, and the severity of injuries sustained So do your paperwork, do it well, and that way, its all good baby baybaaaaay

Scope of Training

Scope continued…

• • • • OEC = standard of training Standard of Care: set by local protocols So, we train you to be able to be the chillest possible, and you follow local protocols to know to what degree you provide care Because other “level of care” providers (i.e. doctors) may be better able to perform more advanced procedures – who wants to see RD perform complicated surgery?

• Me, actually…

Joint Statement of Understanding

• • • When patrolling, you are patrolling as an “agent” of the ski area, and not on behalf of the NSP.

So, NSP doesn’t control the Patrol activities of the bowl.

Steve does.

Consent

• • • • • Before providing care, we need to obtain consent. “May I help you?” “Pleeeeeaaaaaaase?” Expressed Consent: consent given when a competent injured person gives permission to provide first aid treatment and transportation Informed Consent: consent given by a patient in full knowledge of the facts, implications, and possible future consequences of treatment (feeling “all better”) Minor Consent: consent from parent or legal guardian to treat a minor Implied Consent: when someone’s unconscious, or unable to give consent, consent is implied. When you come across people off duty, snoozing in the bottom hut, you do not have implied consent to mess with them, but taking pictures is OK

Refusal

• • Patients can refuse care, so if they refuse then document it, get them to sign it, and let them do their own thing If someone is in life-threatening condition, it’s usually best to provide treatment. The legal risk of not providing treatment outweighs the legal risk of not listening to them

Assault and Battery

• • Assault: placing somebody into a position where he or she reasonably fears that battery will occur Battery: the act of touching someone without his or her consent

Privacy

• • • What happens at the bowl, stays at the bowl.

For real though, you need to keep medical information about injured persons private Don’t tell people’s dirtiest secrets, like what Luke Rahlson keeps under his bed…

Teamwork

• Work as a team. nuff said.

Homework

• • Survivor.

Wednesday nights, 8/7 central, the material will be tested….

Thanks

• Photo cred to Kate, Chloaaay, and Laura Newman